"Advanced Medical Practice Business
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Ezine Magazine     May 2013

"One thing is certain, there is no more powerful force than choice."
--Dan Kennedy


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Discover the strategic methods for reaching your maximum potential as a doctor and never have to worry about having enough income ever again.

Article #45   May 2013

Why Doctors Fail--- Series #7

"Employed Physicians Are Sacrificial Lambs Whose Robotized Job Is To Fill the Pockets
of the Employer”

Physician employers pull out of you only what they need to make the most money from, then throw the rest of you and your incredible capabilities and expertise away.

Your value as an employee is manifested by the degree you kowtow to their system rules and by
your productive capabilities.

You aren’t hired for your looks, personality, how much you know about medicine or even the medical skills you have. Jobs for doctors are available to those physicians who can see the most patients per day (earn the most money for the institution that employed them).

I know that because of how the HMO and another hospital where I had been employed (total = 8 years) measured an employed doctor’s usefulness to them by their productivity and profitability.

The criterion of measurement was almost entirely based on how many patients you saw each day compared to the other doctors.  

When I left my hospital position, the head nurse in the Women’s Clinic was quick to point out that the doctor replacing me was able to see 60 patients a day, while I saw an average of only 25 patients per day. Quality of medical care given was not even mentioned because that wasn’t important enough. For myself… it was. 

I could easily have seen 60 patients a day. Following that path would have violated every personal belief I had about patient treatment and care.

Seeing a rapid flow of patients like that would have left me mentally frustrated, feeling neglectful of my responsibility to patients, and more than anything else, would have documented for me that I had fallen far short of being a good physician.  

How do you go about rating the quality of doctor
you are today?

Many shortcomings related to employed doctors

  1. Your salary and compensation often stay nearly the same
    over the years. The only way that increases in salary occur
    is if you complain, threaten to quit, or somehow become considerably more useful to them… like take on another
    additional job responsibility (work harder... make more
    money for them). It’s not personal… it’s just good
    business… right?

    In private practice you can rather quickly adjust your income
    to a level you are comfortable with. You control the number
    of patients you prefer to see.
  2. You are not in charge of your professional practice activities.
    What you would like to do, beyond your required medical
    activities, has to be approved by another higher-level doctor
    or administrator, or both. If that medical practice treatment or procedure in any way interferes with your profitability in their
    view, you will not be allowed to do it.

    This aggressive push to force physicians to increase their productivity is even more extensive in the present
    day economy.
    These healthcare facilities are only able to survive if they make enough money by persistently pushing their employees harder.
    The bottom line is always the profit motive... never forget that.

    For example, as a physician employee at Kaiser I was
    forbidden to do what was necessary to carry out an
    appropriate infertility workup. I couldn’t keep my nurse
    (assigned to me) overtime because of problem medical issues because it cost Kaiser too much money.

    For Kaiser doctors appointments were rigid. Also,
    appointments were made and assigned to me without any
    choice by me whatsoever, and revisit appointments started
    three months from the date I instructed the patient to request
    a revisit at the front desk on the way out.

    Fit in appointments were forbidden because it interfered with
    my rigid schedule for seeing patients and because all patients
    had to be seen by the time the clinic hours closed. Hour-long consult visits with patients were not possible. All visits at that
    time were 20 minutes in length no matter what.

    Even staff members who suddenly become ill during clinic hours, finding backup people to help becomes a chaotic affair.

    Just think about that for a minute. The patient is brought to the exam room by the nurse. The patient gets into an examination gown. The patient has a full gyn examination or OB check. The patient is counseled by the doctor in the exam room. The doctor returns to his or her desk to make chart notes, or to enter the medical information into the computer records.

    How long does it take for you to manage all that effort? Have
    you actually time tested your process?

    Now assign a number of minutes to each of these actions. If
    you are any kind of conscientious practitioner, you probably
    will notice that the actual time with the patient, actually
    practicing real medicine, is unacceptable for most gyn problems.

    There is no accountability or time set aside for emergencies in
    the office. There was no attention given to unhappy patients
    who would like to kick you in the teeth. There were no time intervals set aside for settling doctor-patient disagreements.
  3. Hospitals present another set of problems for a physician employee, which are most often related to department
    conflicts, turf battles and administrative dictatorial threats.
    Working in a hospital environment is primarily a team effort.
    That means you are subject to open criticism, intimidation,
    and very subtle threats at every turn… and, not just from
    your peers.

    Be aware that the concept of team management of health
    care being promoted today puts you in a position of
    compromise at every turn as well. It’s a concept that medical patients will be treated better, have better outcomes and
    involve far fewer medical mistakes being made… maybe.

    For example, a few intolerable things that happened
    to me...
    • I brought along my Ultrasound machine I had used for 8
      years in my private practice and used it during the first
      three months in my hospitalist position at the hospital Women’s clinic. I was suddenly without warning forbidden
      to use it for any reason in my clinic practice, at risk of
      being fired.

      It happened because the radiology department wanted
      all ultrasounds done in their department only (by their
      sono tech), so they could earn the money. I had to wait
      3 to 4 days for their report to come back. I would have
      had the answer for myself in 10 minutes or less. Medicine
      is a business and it has to make money… right?

      Even more ridiculous was the fact that I, nor the women’s clinic, were billing for the ultrasounds I did on patients.
      I used ultrasound for improving on my diagnostic ability
      on the spot. I also was beginning to teach the Certified
      Nurse Midwives how to use it for their own patients.

      What the “decision makers” were ignorant of was the PR, publicity, and marketing that handing an ultrasound photo
      of a patient’s fetus to the mother does for the hospital’s bottom line over time. It fries my oysters to think of the ignorance that persists in the profession today.

      In addition, the ultrasounds I did for myself were never
      ones that I would have referred to the radiology dept. Besides, I wasn’t so dumb that I would avoid sending a complicated patient problem to the radiologists anyway.

      The hospital hadn’t a clue about the gold mine they had available to them in my ultrasound use.

    • I was involved in a hot discussion with an arrogant nurse in
      the clinic hallway one day, when a supervisor nurse
      standing nearby immediately ordered me in a very loud
      voice to take the discussion into a side office.

      By itself, it was a proper thing to do. However, she did it
      from down the hall in front of several staff members with
      an attitude I could not tolerate. My response was to forget
      the hot argument instantly, walked down the hall to her
      face, and emphatically instructed her to never do that
      again in such a manner.

      She could have handled that professionally without
      offending anyone... and didn’t.

      My actions were perceived by the physician administrator
      as insulting and threatening to the nurse and who then
      threatened me, and my job.

      I was ordered to apologize to the nurse and I didn’t speak
      to her for the next two years. Not because my anger persisted, but because I knew she was more important to
      the hospital than I was, and I was determined not to give
      her a chance to test me again.

    • This hospital was at least ten years behind the hospitals I
      had worked at in my private practice in California. I had already been doing advanced operative laparoscopic
      surgery procedures for over 4 years.

      When I applied for privileges to continue these procedures,
      I discovered that they had no such privileges. I gave them
      the ones my other hospitals had used and the surgery committed granted me those privileges.

      I scheduled a LAVH procedure and ran into problems immediately with the process. The OR supervisor had previously assured me they already had all the instruments needed to do the procedure... they didn’t.

      I was able to complete the procedure properly but with a
      few non-laparoscopic instruments, a prolonged procedure, and my decision to withdraw my privileges to do
      these cases.

      The operating room staff, I discovered, had not been
      trained for this type surgery, the necessary instruments
      hadn’t been purchased, and under these conditions the
      risks were too high all the way around.

      As it turned out I was never able to teach the other doctors what I knew about this kind of surgery (they could have learned a lot from me). I felt disappointed that I had skills
      that would never be used again. And the medical staff
      made no attempt to improve their skills and capabilities
      for advanced surgical procedures for the five years
      I was there.

      In private practice, you replace the nurse immediately. In addition, you are treated with much more respect when
      you are paying your office staff salaries. As an employed physician you are powerless to make those things happen. Why? Because it’s easier for the hospital to replace you
      than their own long-term employees.

      I know that is true because of an event during my OBG residency. After an interchange of words with the Chief of Service’s secretary one day, the Chief told me in no
      uncertain terms that it would be “much easier to replace
      me” than it would be to replace his secretary of
      some 15 years.


Remember that each doctor in an employed position is subject to many professional and personal rules that may not be tolerable. With the independence factor built into most medical doctors, every employed physician can expect to have their independence compromised in many ways.

Many physicians are adaptable to the compromises they must make, because of their personal, monetary, or personality reasons. However, there is truth to the fact that every doctor employee to some degree resents being told what to do.  

The aspects that trouble physician employees the most are how patients are being treated in mass-medicine facilities. Medical students develop a close rapport with their patients and have an inherent passion to treat them with respect and dignity. Every graduating doctor has their own well-established ideas about how they want to treat their patients.  

Unfortunately, the reality of circumstances within the healthcare organization they work for inevitably chip away at those ideal patient treatment concepts. It continues until they have indoctrinated doctors into compromising almost everything they had learned and believed about how medicine should be practiced. 

When employed doctors reach their ethical, moral and principled tolerance level, they quit their employment regardless of the consequences they will face after that. A professional can only be pushed so far.  

In today’s world one slip-up, confrontation, or medical mistake while employed puts you on the list for possible termination of employment. It is quite evident that today in 2013 hospital and managed care employers are much more prone to terminate your employment because of the thousands of doctors waiting to take your job.  

I’m talking about the 50% of graduating medical students that are headed for employed positions.

The advantages of an employed position today (with horrendous educational debt hanging over their heads) may not give large numbers of young doctors much choice
in the matter. 

“If you have a poor financial education,
you will always work for the rich.”

                                                   ---Robert T. Kiyosaki

For the right doctor in the right circumstances and situation, some of those employment advantages are...  

  • Practice schedules are usually 9 to 5, five days per week. Some doctors have night-call but very infrequently.
  • You are paid starting immediately and remain at that pay level for the length of your contract or you agree to take on a higher-level job with them. At Kaiser after 3 years you become a partner and share in profits they make, on top of your salary, unless they have changed their compensation system for doctors.
  • You have much more time with your family.
  • Your benefits are very good including health insurance, medical malpractice coverage, vacation time, medical meeting and education coverage.
  • You will have higher paid and experienced staff to
    work with.
  • Once you have experienced an employed position, you always have the option to leave and go into private practice, often with an established private medical practice group.

Final considerations concerning physician employees

Because I have practiced a significant amount of time in both the private and employed sectors, it allows me to understand why doctors make the decisions they do regarding their medical practice choices.

My strong belief is when you permit yourself to settle into an employed position practicing medicine, you are inevitably destroying a significant amount of the talent, skills and knowledge that you spent so much time and money to accomplish, then never use.

In doing so you have in a sense betrayed yourself by eliminating opportunities you would otherwise have to magnify your ultimate potential as a physician, to reach complete fulfillment, and to drive your skills and knowledge to the maximum you are capable of attaining.

The failure you should consider here, and happens here, is the result of the sequential series of choices you made
along the way.

It’s not that you can’t fix it, but that most don’t make any attempt to step out of a less than satisfactory sticky situation for any of a thousand reasons.

“You cannot improve your future if you are not
willing to try something new and risk
making mistakes and learning from them.”
 --- Robert Kiyosaki

The way I view physician employment may distress you. However, who in your medical life has ever pointed out to you what you are leaving behind in the process. I understand that you may not have a choice of how you spend your medical career, but you should understand clearly the compromises you are making as an employed physician.

The future of medical education is predictable. With the elimination of private medical practice in our country soon, it is quite obvious that medical education will need to be restructured to supply doctors who will fit into employed positions rapidly.

Graduating physicians must be mentally trained to be satisfied with “managed care” medicine and are willing to tolerate a significant lack of professional independence. Any doctor who thinks that this authoritarian infrastructure of health care won’t happen in the rural areas doesn’t truly understand the extensive nature of the threat.

“Creativity is letting go of certainties.”

Believe me, I left a lot of things behind during my physician
employment years, which I regret to this day. A few examples of those I have told you above. But, there are many more and some even worse to think about.

The author, Curt Graham, MD, and experienced physician, author, marketer and
expert in medical practice business and marketing strategies, motivator of
professionals in the business world, published widely in web article directories,
in Modern Physician and Medical Economics Magazines, and has three books
available online.
Discover how to make your medical practice flourish and
exceed all expectations with simple business and marketing strategies.
Click this link now:
© 2013,  All Rights Reserved

handwritten signature of Dr. Graham

 Business Nudges......

Physicians who are employed will find themselves in the same situation that this parachutist iphoto of man parachuting into an alligator ponds in.

There will always be administrative and peer alligators ready to sink their teeth into you. And if you are not able to discipline yourself to that kind of career life, you'd better already have a back-up plan for the rest of your medical career. Practicing medicine in that sort of environment will eventually become intolerable and a source of disappointment.

You are trained during medical school to be an independent thinker and practitioner. Those virtues are lost when you are employed.


photo of Dan Kennedy

Renegade Millionaire

By Dan Kennedy

The Not-So-Secret Recipe

In 1985, his father died, leaving behind a neighborhood tavern that was losing money and a mountain of debt accumulated keeping the joint open. John juggled it with the opening of a new, hopefully better business, a pizzeria.

It is the 3rd largest pizza chain, behind Dominos and Pizza Hut, with $3-billion in annual revenue. Papa John’s. Better Ingredients. Better Pizza. John Schnatter aka. Papa John follows “characters” like Col. Sanders and Dave Thomas, fast food chain founders who became the iconic figureheads of their companies – themselves the key differentiator in a crowded field. An ingredient.

But what are the other key ingredients?  How do you go from one tiny shop in a small Indiana town to a global empire and a personality brand everyone knows? This is the question everyone could ask themselves.

Since this is the day of casting the rich and successful as villains, an answer to that question is: luck + viciously profiteering from others’ misery; in John’s case, slavery i.e. low wage workers and selling poison that causes obesity. He was not unaware; he constructed his home to be deceptive, tunneling underneath, to hide his multi-car garage and movie theater. But then he slipped. 

Here is how unfunny comedian Bill Maher reacted, after John made it known that a doubling of health insurance costs for the 80,000 employees in his system was an economic bomb they could not simply absorb:

“The filthy-rich founder of Papa John’s, John Schnatter said he’d cut his employees’ hours to avoid the costs of ObamaCare. This is where I’d normally suggest boycotting Papa John’s, but that’s like telling people to boycott sadness. Nobody eats Papa John’s because they like it. They eat it because Dominos won’t deliver to crack houses.”

That wasn’t said in late night oblivion on cable. It was in Maher’s editorial in The New York Times. Schnatter has been dealing with an orchestrated, relentless political and media attack ever since hosting a Romney fundraiser and having a video go viral on You Tube in which Romney said: “Who would have imagined pizza could build this! What a home this is! What grounds these are! The pool! The golf course! If a Democrat were here, he’d say no one should live like this. But Republicans come here and say everyone could live like this.”

In calling attention to John’s wealth, Romney turned the friendly, red shirted guy seen in his pizza places watching over quality, even delivering pizza himself – Papa’s in the house! into a red-eyed demonic money-grabber.

Then, when John made a comment about the structural changes in employment ObamaCare would force on his and countless other companies, the media pounced. His company’s #1 asset, his image, put at risk, and costly PR combat required. Fortunately, the average consumer is not all that dialed into these things, and if they have Papa on their speed dial, this too shall pass. But it speaks to the dangers in
visible success.

Looking at anyone like John late in their story, when the mansions, the cars, the flashy donations (his, a 55,000 seat Papa John’s stadium at the University of Louisville), etc. have come, no one sees the ugly, grimy, fighting for survival beginnings, the flop sweat and sleepless nights wondering if this’ll be the week payroll won’t be met, the YEARS
of sacrifice. 

So here is the real answer to how you go from a small shop to a global empire and earn your wealth. In 1985, John was out late at night, night after night, fishing soiled copies of customer lists and delivery notes from dumpsters behind Dominos outlets, so he could directly pursue those customers and persuade them to try his better pizza. (It reminds me of me, putting my lead generation cards under windshield wipers of cars in hotel parking lots where someone else was holding a seminar.)  

You do whatever it takes. You do what no one else will do. You risk as others will not. You even steal – as this dumpster diving was theft; it’s said there’s a crime behind every fortune. You scrap and struggle and survive and find a way forward and upward. There is no other answer. 

DAN S. KENNEDY is a serial, multi-millionaire entrepreneur; highly paid and sought after marketing and business strategist; advisor to countless first-generation, from-scratch multi-millionaire and 7-figure income entrepreneurs and professionals; and, in his personal practice, one of the very highest paid direct-response copywriters in America. As a speaker, he has delivered over 2,000 compensated presentations, appearing repeatedly on programs with the likes of Donald Trump, Gene Simmons (KISS), Debbi Fields (Mrs. Fields Cookies), and many other celebrity-entrepreneurs, for former U.S. Presidents and other world leaders, and other leading business speakers like Zig Ziglar, Brian Tracy and Tom Hopkins, often addressing audiences of 1,000 to 10,000 and up.  His popular books have been favorably recognized by Forbes, Business Week, Inc. and Entrepreneur Magazine. His NO B.S. MARKETING LETTER, one of the business newsletters published for Members of Glazer-Kennedy Insider's Circle, is the largest paid subscription newsletter in its genre in the world.

Click the link below and take advantage of the free gift which will make you wealthy if you follow the advice!


Articles © 2008/Glazer-Kennedy Insider’s Circle LLC.


In Every Issue:

1. Powerful Business and Marketing Articles You Can Easily Adapt to Your Own Medical Practice.

2. Dr. Graham's Practice Views And Opinions That Should Provoke New Ideas For You to Act on.

3. References For
Maximizing Your Medical Practice Potential, Income, and success.

4. Businesses For
Your Kids. The Smartest Thing A Parent Can Do For Their Children Is To Teach Them Business Tactics And Strategies, And Stimulate Them To Start Their Own Business
At Any Age.

5. VIP Newsletter Articles Library. Cutting Edge Articles Telling You How To Grow Your Practice In Any Economic Environment.

6. Practice Ideas And Tips For Improving Your Practice Income
And Efficiency.

7. Library Of My Views About Medical Practice. Practice Alternatives, Problem Solutions, And The Things You Should Do and Should Not Do.

8. List Of My Medical Business Websites Meant To Offer You Another Whole New Look AT How Your Medical Practice Interacts With Other Medical Career Demands + Responsibilities. 

9. Humor In Small t.i.d. Doses. Meant to lighten your stress load, if even for just a few  minutes.

Profitable Practice Tips

Social Media in Healthcare:

LinkedIn.com is a professional networking site for 200 million members to find jobs, connecting to other healthcare professionals.

PatientsLikeMe.com is a website for patients with serious diseases such as ALS and MS. Paul Wicks, neurophysiologist and research director is creating a learning health care system for these medical problems that there is no treatment for.

PracticeFusion.com provides a cloud-based med. records system for doctors.

PatientFusion.com allows patients to give their reviews of doctors.

ZocDoc.com is a service that doctors subscribe to to handle their patient appointment scheduling.

HealthTap.com is a hub of 1.2 million doctors world wide who field medical questions from anyone, anywhere.

All four sites is where patients are able to compare doctors, write reports about doctors, and do background checks on doctors.

Source: Fortune Mag.Apr. 29, 2013, pg 54

Borderless Humor

"After eating an entire bull, a mountain lion felt so good he started roaring. He kept it up until a hunter came along and shot him.
The moral: When you're full of bull, keep your mouth shut."


Goals - Plans

Student, A. J. Forsythe, at Calif. Polytechnic State Univ. had always been a tinkerer. He decided to fix his own mobile phone, did it, saved over $300 in repairs. He went on to create iCracked--the iPhone, iPod, and iPad repair and buyback service out of his dorm room.

He partnered with Dave Mazurek and they have a flourishing business in York, PA.

Source: Entrepreneur, May 2013

Inspiration Time

"The more difficulties one has to encounter, within and without, the more significant and the higher in inspiration his life will be."

---Horace Bushnell

Views I Only Share With My Friends--

What my medical career taught me.......
Click Here... and how it can help you manage your medical practice business at the highest level of expertise.

 Facts And Stats

Best Education and Career Sites:


Source: PC World.com
May 2013

What Your Kids
Are Capable Of-

When you want to understand what your modern day kids are capable of and have the ability to do, regarding starting a business of their own, then hit the link below and give yourself a dose of inspirational enlightenment.....


New Important

My New Ebook, the keys to your medical practice survival is now available:

" How To Rapidly Propel Your Medical Practice Income To Unlimited Levels In 6 Months"
Click Here When you need expert help and advice, and when........

red arrow pointing to right you just don't know where to turn to get honest and reliable help with your battle to fight the external forces that compromise your practice revenue and growth.

red arrow 
                    pointing to rightyou want to improve your medical practice income dramatically in a short period of time.

red arrow pointing 
                    to rightyou prefer to find the means to reach your highest level of practice income and productivity.

red arrow pointing 
                    to rightyou demand effective and reliable means for preventing the financial collapse of your medical practice.

red arrow pointing 
                    to rightyou are determined to find ways to combat govt. fee restrictions that continue to increase.

red arrow 
                    pointing to rightyou recognize that what you are missing in your medical business are implementation of business principles and marketing strategies.

red arrow pointing to rightyou want to do it yourself and save a bunch of money.

red arrow pointing to rightyou are sick and tired of putting up with what you are being forced into doing with your practice to stay afloat.

red arrow pointing to rightyou are aware that no other physician author is making any effort to tell you what to do and how to do it effectively to reach your expectations you had for your medical career when you started.

red arrow pointing to rightyou understand the severity of being in a business without ever being taught the business knowledge to run it profitably.

red arrow pointing to rightyou insist on having a blueprint for your medical practice business that provides every key to your practice success at the highest level. 

References For Maximizing
Outside Income

best references for doctors who invest.......

For Investing advice:


2.The Palm Beach
   Letter--Mark Ford

3. Retirement Millionaire Newsletter.......
published by David Eifrig Jr., MD, MBA, Ophthalmologist, stock  market expert. (my choice) Subscriptions
call 888-261-2693

Note: I have no personal or business connections with these references other than subscriptions to their publications.  I suggest them because I do think they have unique value for investors. 
You decide.

My Other Medical Websites






coaching.com (coming July 2013)



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            lying on back with feet up in the air


  photo of Dr. Graham with two corpsmen in Vietnam 1965       photo of Dr. Graham early in practice        photo of Linda Dr. Graham's wife         photo of Dr. Graham late in practice        photo of Dr. Graham's practice associates    

Flight Surgeon Vietnam1965--

Diet Worked 1980

 My Wife Linda

Retired 1999

Our Medical Practice Group
Graham, Mayo, Kaplan, Seibert, DelValle, Chuba

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Curt Graham, M.D.
2404 Mason Ave.  Las Vegas, NV 89102
E-mail = cgmdrx(at)gmail.com
© 2004-2015  Curtis Graham, M.D.,  All Rights Reserved.